If you are a doctor, the odds are that your patients think or do things you don’t agree with. Nearly half of Americans believe at least one health-related conspiracy theory, people routinely lie to their doctors about how much they drink, and many act on health information they find on social media without checking with their doctor first. In fact, most adults report hiding information from their doctors.
While some say the onus is on patients to be more forthcoming, this discounts patients’ concerns about what may happen if they do share their views or behaviors. Patients may not volunteer that they modify the dosing of their medications, or that they don’t really exercise every day, out of fear that their doctor will lecture or develop a negative impression of them.
In a recently published study I found that patients are right to worry: Doctors do judge patients negatively based on the accuracy of what they say.
My colleagues and I surveyed more than 200 primary care doctors, giving them hypothetical questions about patients who shared beliefs of varying correctness. We found that doctors viewed patients more negatively the more incorrect their beliefs. A hypothetical patient who shared that “CBD oil reduces blood sugar” was judged negatively but less so than a patient who shared that “Drinking carrot juice will cure diabetes.” The effect was stronger when patients shared false information that was more relevant to their disease — exactly the information that most affects a patient’s care. While we examined judgments based on beliefs — not behaviors — we might expect similar results when patients share behaviors that their doctors do not approve of, like drinking or drug use.
Instead of only encouraging patients to be more candid with their doctors, which my collaborators and I show may come at a cost, doctors need to change their mindset to focus on empathy and education. That way, patients can share freely without being penalized for it.
Resisting the impulse to judge is hard, but empathy can counteract it. Empathy is also a skill that can be taught, as educational interventions with doctors have shown. Improving empathy requires connecting with patients as individuals who have different backgrounds, needs, and beliefs. Practicing perspective taking — imagining what it would be like to be a patient and seeing things from their point of view — can increase both empathy and patient satisfaction.
Physicians may rightly worry about taking on more emotional labor when many already struggle with burnout. Yet, when interns attended a course designed to improve empathy, they had less emotional exhaustion (a part of burnout), while their empathy increased. Many other studies show similar results: Rather than contributing to burnout, empathy may be part of its cure. A more empathetic patient encounter does not have to be a longer one — acknowledging a patient’s feelings, or wrapping information in brief messages of emotional connection (the heart, head, heart technique), takes seconds. Empathy can also improve health care. Studies show that patients are more likely to trust and follow recommendations from doctors they perceive as empathetic.
Enabling patients to share their beliefs freely without judgment could help them avoid self-diagnosing with Dr. Google. While the vast majority of patients do online searches about their symptoms before seeing a doctor, this can also lead to not receiving necessary medical care and encountering misinformation, like videos with millions of views that incorrectly state that putting potatoes in one’s socks can cure a cold. If patients are judged on their knowledge, they may rightly treat their doctor’s appointment as an exam they need to study for. Some of this reading may be helpful, but at the same time patients seek to become more informed, they risk becoming less so.
Doctors must remember that patients are seeking out their professional opinion and should not hold patients to a professional standard of knowledge. Patients sharing what they believe provides an opportunity to educate them, including about how to find trustworthy sources of health information. Further, while patients are not medical experts they often bring important understanding of their own health. Patient reports have provided some of the first clues into severe side effects of new drugs, like the discovery that the drug combination fen-phen caused heart damage.
Chatbots or surveys that patients complete at home or in a waiting room could allow patients to disclose important information without having to say it aloud. Yet people would rather tell a doctor — not a chatbot — even potentially embarrassing information. Ultimately, information is shared with the same physician and there is no reason to believe doctors will be less judgmental about information disclosed on a form. No matter how patients provide information, doctors must strive to not judge them for it and not allow their reactions to impact how they interact with patients.
The doctor-patient relationship is an asymmetrical one from the start, especially when a fully clothed doctor walks into a room where a patient is vulnerably exposed in just a gown. Patients’ experiences shape how they interpret what doctors tell them, but it is not enough to tell patients to be forthcoming. Doctors need to recognize that ultimately patients are not experts and that to err is human — for patients too.
Samantha Kleinberg is the Farber chair professor of computer science at Stevens Institute of Technology and author of “Why: A Guide to Finding and Using Causes.”